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BUILDING- INSPECTOB RECORD
<br />DATE ID/SIG.COMMENTS owNllR BUI!,DllR Dr:i-c^RAl lON
<br />I h.rchy.ffirm trndq pc.nlry 0f pcrjury rhd I er.xc rlr fiom thr Clrlri.rorr Licensc Lls lor lhc lillowing r.N (Sfr70:ll5
<br />Burnr\\ anl Piofi\sion Codc): Atry Crty or Contrry which r.qulrc{ r |i.rnir i) coD{rucr, rlrcr. i'npnrvc. dcndth .r r|Ji' try
<br />{d.rurc. rrntrh irs tsum.c.,lso rcquncsrhc npplicanr for u.h rEnnirni,ih r siSmd dddrr ihd lEot shc k liceNcd iut\ulnr
<br />t, rhc pmlni,nis of rlr Conta.ror's l,i..trscd L.B (Chalrcr 9. GnnmNinS wih Sc.lion 7(X)0 of Diri\n,n I of rhc Bun&rs ind
<br />Prnt\sions(hdc)orthrlfuorshci\crcnrrrrhcrcfrotrrrndrhchr\i\f{nrh.xlLlcdcx.nlprn.AnyvirtriorolS.di(n,70.ll5hyrtry
<br />appli.rl n, r rermir srbj(h rhc amlrnnr ro rcivilp.inkyornor.rorcrhtr livc hundrcddo]lr\ rsslx,
<br />Lrs osncrolrhcpdpcay,ortrrycn1 .)ccs Birh wi8csaslhct nne compctr\irion. Nilldo rhc w.rk d rhcsMrurchmr
<br />n cndcd orollcrcdiorslc(Sa7(!,l.EusincssndPnn$ionsCod.'lhcCont".tr'st-i.cn\cLawdocs.orapplynr,trosncrol
<br />rlt pnTcny who hoilds r introvc( ILB,n.0d who &rs such ubd hinxcllor hcr.lfor rhR,ush hi\ or hcr os'n cndoyc.\.
<br />provid.d rtur ch inpnlcnrnrsmfr i, .klcd oroffeftd ror$k lt howcvcr. rhc hilding or irq'ft,vomnr i( \rrl wirhiroDc )eir
<br />.f .orylcrion. rh. Owrcr Buil&r eill h.vc rhr turdcn of lxring rlli h. ur shc did tror huild or impror! th€ nn'Iql) fff Ihf, purF)y of
<br />_l. rsowncrolrhc pmFnr. r lcx.hrn.ly.oitn rin! snh licri\cd.otulckrs nr mn{rucr rh. pr+d (Scc 7Ol-4,8u!Dc$
<br />,'xl lhfrs\in Codc: Thc Contrrlol s t-iccrr Low docs nor alinly h !f oBncr o f popc y wh() boilds rr imlrore\ rhc'.on.
<br />rnd who co rch for such prcjffc $irh n Conhck,n n ljcciscd tursurnrk,rhcconnlcxn s l,iccn\c !,tr*)
<br />I rn.\rn,l trfdcr S.!r(nr
<br />I)rle ()sn.r:
<br />\voRKFR$ C(rUPr-ILSAITON
<br />DLCLIBAIIOII
<br />I hcrchy,rrifln und.r p.nalryot t'crjury oN olrhc follosin8 dcclirarion\:
<br />lh.vc.Jwillnminr!ire(cnlficaicolC.ns.trriosclll'xurcft*oikcF.onr|xnsnri(nr.rsproridctllbrhyscrriinrlTmofrhc
<br />ljtx, cod.. {$rhe pcrrorntrrccollhc *ork for*hich rhc pcmrir i\ is\ucd
<br />Ihnvcin(lwillnrinlrirworkcrrcomptn\rrionin\urrm..^rquncdhlSc.!i(nrl7U).lrhctihorG..fo ht|f,rhi,Mrrcol
<br />lfu *orklor *hi.h lhh pcmrir is i\su.d M,workcn c.mp.i\rri,nr itrrunfcccmicr md nolicynumtrr rc
<br />Lt+yttk /fr,twiLit n
<br />'ttr;i,, i{1 i"l lrq I D "l llt /l )wt
<br />Icrnifyrhrrintlf, IxrfonNnccofrlrc trort tur *hich rhis Dcflnil ir i\\kd.I shdll nor.nr oyanytE6on in onynrnncr
<br />$ r\ r,, bcqnrE luhjccr t, rhc $.r[cr! cofrptnsin,n h*\.rCrlir,mi.. i.d.Erc. rhrr irl should tEcoft subj..r u lhc
<br />worlcn conD.n\arionpr,!i\i,,ns.fScdn,n lTlX)ol rhc Lltsr Corlc.lcttrll- l.nhwirhconrly siih r,a,{ polniotrr
<br />W llNlN(;: Fdlurc o ccurc workcr coDpcns.li,,n covcrl8c ir uilNful, and d l (uhlc.l r. c {lqtr h rinir lJf,mlric\ ni
<br />rNll hrcs ut tu otrc hu drcd rhousrtrd dolh6 ($|U,.([n). in !.ldirion kr rht.u{ ol..n nslltiotr. d!nugc\ xs nmvitlcd lnr rlt
<br />sr!'n{r ruTn "l 'hc Lih{ (ialc. i'fcrcq Jntlrtrnrm}'\ fcc\w,qla!1 ,rrU,,.-r,(-h"A\?)
<br />l)Illn8!l!2\
<br />I hcEbyainfln undcr F.alry olrojrry rhd I r licnrd u dcr lnvnion ol Ch3fl.r 9 (cointui. ing *irh SElhn Trxx) or Divisiotr .l
<br />rl rhc Busincss Md Pdcsions Codc.,nd.ry li.nic I in fullftr.. rd cl'fsr
<br />,,,2a
<br />TBW:#"W,
<br />I c drr's /\ddrrs
<br />ATTLICANLIJiIIAEAIIQN
<br />I llrhyxlllnnuftl.r p.n,lry ol l.rlury.trc.f rhc foll,!win! d(l.rrridr:
<br />l)cnrniion Pcrmir\ A\h(do\ Noril,.ari(,n hd.rdlRcFUldrio.\ llirlc.l0, Frn6r
<br />_Rcquircd lxrrcr of Norifi cdioi
<br />I ccnili rl rrhc fcd.nl tu!uld i,)rr r.lnfttrtr3 i\h.{.r rcnnniLr. nor xfph.rilt r) lln\ t)n,lccr
<br />-lccniiyrh*Ihryer.rdrhi\rmlicri()nndnrtcihnrthch)v.nr,nrnrdi([ircorcc(lrgr.!i,cordttrnhnl]Ciry!!dCounryo inrNcsrnd Srdc LnwsEl,rin! robllld E..n(ru.ri(,n, drl hcrcb, Nlktrizc rcprc{nr iv.soilhisCirydndCoutrryto.orcrtrFrrhc
<br />LL\{r+r,.op-tti t LinLS*::il:ffiry"ry 1f t't lrl
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino /2-Z-/6 ,/L/,-{1 , Eq)
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />l\4aso n ry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL eM.h t6-10-rg
<br />Certiricate of Occupancy
<br />Notes, Remarks, Etc
<br />-}
<br />SITE-WORK
<br />loNualcllglt.LEuDlNc-dQENrI
<br />I hcrcby afi!, undcr p€nrXyofp.rjrry rh thLJc isaconirucri'n lctrditr8a8c&y fttrrh. P(fomhrc olrhcwork ior shichd,t Fnnn t
<br />issucd (Scc 1097.Ci!. C )
<br />lc.Jcr-. Nrn'c
<br />-
<br />SLAB Floor
<br />Shear Wall
<br />Pool Fence
<br />Flood Zone Cenif .
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